GENEL PEDİYATRI SERVİSİ HASTALARINDA POTANSİYEL İLAÇ-İLAÇ ETKİLEŞİMLERİNİN SAPTANMASI: BİR KESİTSEL ÇALIŞMA

Öz

Amaç: Bu çalışma, hastanede yatan hastalarda potansiyel ilaç-ilaç etkileşimlerini (pDDI'ler) belirlemeyi ve iki ticari ilaç etkileşimi veri tabanını karşılaştırmayı amaçlamaktadır. Gereç ve Yöntem: Bu prospektif kesitsel çalışma, Şubat ve Mayıs 2022 tarihleri arasında üçüncü basamak bir hastanenin genel pediyatri servisinde yürütülmüştür. pDDI'leri belirlemek için UpToDate® ve Micromedex® İlaç Etkileşimi veritabanları kullanılmıştır. Sonuç ve Tartışma: Elli bir pediatrik hastanın ilaç listesinde toplam 267 pDDI bulunmuştur (UpToDate® aracılığıyla 181 ve Micromedex® aracılığıyla 86). En az beş farklı sistemik ilacın aynı anda kullanımı, en az bir pDDI saptanmış ve saptanmamış hasta grupları arasında istatistiksel olarak anlamlıydı. İkili lojistik regresyon analizi, bir hastanın hastanede yatışı sırasında aldığı toplam ilaç sayısındaki bir ilaç artışının, pDDI olasılığını 2.12 kat artırdığını göstermiştir (GA: 1.321-3.417, p=0.002). pDDI saptnmasında UpToDate® ve Micromedex® veritabanları arasındaki uyum oranı %84.31 olarak bulunmuştur (kappa katsayısı=0.676, standart hata=0,102, (p ≤ 0.001)). UpToDate® veri tabanı referans veri tabanı olarak kabul edildiğinde, Micromedex® veri tabanının pDDI'leri belirlemedeki hassasiyeti, özgüllüğü, pozitif prediktif değeri, negatif prediktif değeri ve doğruluğu %79.41, %94.12, %96.43, %69.56 ve %84.5 idi. Bir pDDI'yı atlamaktan kaçınmak için çoklu ilaç etkileşimi veritabanlarının kullanılması faydalı olabilir.

Anahtar Kelimeler

• Çocuklar
• ilaç etkileşimleri
• klinik eczacı
• pediyatrik hastalar

DETERMINATION OF POTENTIAL DRUG-DRUG INTERACTIONS IN GENERAL PEDIATRIC WARD PATIENTS: A CROSS-SECTIONAL STUDY

Öz

Objective: This study seeks to identify potential drug-drug interactions (pDDIs) in hospitalized patients and compare two commercial drug interaction databases. Material and Method: This prospective cross-sectional study was conducted between February and May 2022 in a tertiary care hospital's general pediatric ward. UpToDate® and Micromedex® Drug Interaction databases were used to determine pDDIs. Result and Discussion: In total, 267 pDDIs were found in 51 pediatric patients' medication lists (181 via UpToDate® and 86 via Micromedex®). The use of at least five different systemic drugs concurrently was statistically significant between groups of patients who experienced at least one pDDI and those who did not. The binary logistic regression analysis showed that a one-drug increase in the total number of drugs a patient received during hospitalization increased the probability of pDDIs by 2.12-fold (CI: 1.321-3.417, p=0.002). The concordance rate between UpToDate® and Micromedex® databases for pDDI determination was 84.31% (kappa coefficient=0.676, standard error=0.102, (p ≤ 0.001)). When the UpToDate® database was assumed as a reference database, the Micromedex® database's sensitivity, specificity, positive predictive value, negative predictive value, and accuracy in determining pDDIs were 79.41%, 94.12%, 96.43%, 69.56%, and 84.5%. To avoid missing pDDIs, utilizing multiple drug interaction databases may be of benefit.

Anahtar Kelimeler

• Children
• clinical pharmacist
• drug interactions
• pediatric patients

Kaynakça

1. 1. Dai, D., Feinstein, J.A., Morrison, W., Zuppa, A.F., Feudtner, C. (2016). Epidemiology of polypharmacy and potential drug-drug interactions among pediatric patients in intensive care units of us children’s hospitals. Pediatric critical care medicine: a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies, 17(5), e218. [CrossRef]
2. 2. van den Anker, J., Reed, M.D., Allegaert, K., Kearns, G.L. (2018). Developmental changes in pharmacokinetics and pharmacodynamics. Journal of Clinical Pharmacology, 58(10), S10-S25. [CrossRef]
3. 3. Lima, E.D.C., Camarinha, B.D., Ferreira Bezerra, N.C., Panisset, A.G., Belmino de Souza, R., Silva, M.T., Lopes, L.C. (2020). Severe potential drug-drug interactions and the increased length of stay of children in intensive care unit. Frontiers in Pharmacology, 11, 555407. [CrossRef]
4. 4. Feinstein, J., Dai, D., Zhong, W., Freedman, J., Feudtner, C. (2015). Potential drug-drug interactions in infant, child, and adolescent patients in children's hospitals. Pediatrics, 135(1), e99-108. [CrossRef]
5. 5. Kheshti, R., Aalipour, M., Namazi, S. (2016). A comparison of five common drug-drug interaction software programs regarding accuracy and comprehensiveness. Journal of Research in Pharmacy Practice, 5(4), 257-263. [CrossRef]
6. 6. Reis, A.M., Cassiani, S.H. (2010). Evaluation of three brands of drug interaction software for use in intensive care units. Pharmacy World & Science, 32(6), 822-828. [CrossRef]
7. 7. Roblek, T., Vaupotic, T., Mrhar, A., Lainscak, M. (2015). Drug-drug interaction software in clinical practice: A systematic review. European Journal of Clinical Pharmacology, 71(2), 131-142. [CrossRef]
8. 8. Vonbach, P., Dubied, A., Krahenbuhl, S., Beer, J.H. (2008). Evaluation of frequently used drug interaction screening programs. Pharmacy World & Science, 30(4), 367-374. [CrossRef]

9. 9. Ofori-Asenso, R., Agyeman, A.A. (2016). Irrational use of medicines-a summary of key concepts. Pharmacy, 4(4), 35. [CrossRef]
10. 10. Hassanzad, M., Tashayoie Nejad, S., Mahboobipour, A.A., Salem, F., Baniasadi, S. (2020). Potential drug-drug interactions in hospitalized pediatric patients with respiratory disorders: A retrospective review of clinically important interactions. Drug Metabolism and Personalized Therapy, 35(1). [CrossRef]
11. 11. Getachew, H., Assen, M., Dula, F., Bhagavathula, A.S. (2016). Potential drug–drug interactions in pediatric wards of gondar university hospital, ethiopia: A cross sectional study. Asian Pacific Journal of Tropical Biomedicine, 6(6), 534-538. [CrossRef]
12. 12. Ismail, M., Iqbal, Z., Khan, M.I., Javaid, A., Arsalan, H., Farhadullah, H., Khan, F., Khan, A.Z., Nasir, F., Khan, J.A. (2013). Frequency, levels and predictors of potential drug-drug interactions in a pediatrics ward of a teaching hospital in pakistan. Tropical Journal of Pharmaceutical Research, 12(3), 401-406. [CrossRef]
13. 13. Bebitoglu, B.T., Oguz, E., Nuhoglu, C., Dalkilic, A.E.K., Cirtlik, P., Temel, F., Hodzic, A. (2020). Evaluation of potential drug-drug interactions in a pediatric population. Turk Pediatri Arsivi, 55(1), 30-38. [CrossRef]
14. 14. Choi, Y.H., Lee, I.H., Yang, M., Cho, Y.S., Jo, Y.H., Bae, H.J., Kim, Y.S., Park, J.D. (2021). Clinical significance of potential drug-drug interactions in a pediatric intensive care unit: A single-center retrospective study. PLoS One, 16(2), e0246754. [CrossRef]
15. 15. Medina-Barajas, F., Vazquez-Mendez, E., Perez-Guerrero, E.E., Sanchez-Lopez, V.A., Hernandez, C., II, Gabriel, A.R., Huerta-Olvera, S.G. (2020). Pilot study: Evaluation of potential drug-drug interactions in hospitalized pediatric patients. Pediatrics and Neonatology, 61(3), 279-289. [CrossRef]
16. 16. Tavousi, F., Sadeghi, A., Darakhshandeh, A., Moghaddas, A. (2019). Potential drug-drug interactions at a referral pediatric oncology ward in Iran: A cross-sectional study. Journal of Pediatric Hematology/Oncology, 41(3), e146-e151. [CrossRef]
17. 17. Langerova, P., Prokes, M., Konvalinka, M., Furstova, J., Urbanek, K. (2013). Incidence of potential drug interactions in medication prescriptions for children and adolescents in the university hospital olomouc, czech republic. European Journal of Pediatrics, 172(5), 631-638. [CrossRef]
18. 18. Tecen-Yucel, K., Bayraktar-Ekincioglu, A., Yildirim, T., Yilmaz, S.R., Demirkan, K., Erdem, Y. (2020). Assessment of clinically relevant drug interactions by online programs in renal transplant recipients. Journal of Managed Care & Specialty Pharmacy, 26(10), 1291-1296. [CrossRef]